The Impact of the Covid-19 Pandemic on Osteoporosis Diagnosis and Treatment in Iran: A National Study Publisher



Hajivalizadeh S ; Sanjari M ; Khalagi K ; Mansourzadeh MJ ; Shahsavari S ; Aghakhani A ; Effatpanah M ; Shahali Z ; Hajivalizadeh F ; Zarepour P ; Montazerlotf P ; Hesari E ; Fahimfar N ; Ostovar A
Source: International Journal of Endocrinology and Metabolism Published:2025

Abstract

Background: The emergence of the COVID-19 pandemic disrupted the management of non-communicable diseases, including osteoporosis. Objectives: This study aims to investigate the impact of the COVID-19 pandemic on osteoporosis diagnosis and treatment in Iran. Methods: This cross-sectional study evaluated changes in the number of prescriptions for osteoporosis diagnosis and treatment before and during the COVID-19 pandemic from all available and complete data. Data on the number of prescriptions for bone mineral density (BMD) tests, osteoporosis-related lab tests (serum vitamin D level and serum calcium level), and medications (alendronate and calcitonin) were obtained from the Iran Health Insurance Organization (IHIO) dataset from March 2019 to March 2022. Additionally, the University of Sheffield provided the number of fracture risk assessment tool (FRAX®) used with the internet protocol (IP) addresses of Iran from 2019 to 2023. Statistical analysis was performed using the Mann-Whitney test and the interrupted time series analysis utilizing STATA. This research was carried out with the support of the Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran, under project code 1400-02-103-1177. Results: A total number of 4,901,027 prescriptions composed of 62,718 prescriptions for BMD tests, 2,862,871 prescriptions for serum vitamin D level tests, and 1,952,600 prescriptions for serum calcium level tests regarding diagnosis, and a total number of446,791 prescriptions, including 388,519 alendronate and 58,272 calcitonin prescriptions regarding treatment, were evaluated. A statistically significant decrease in the number of prescriptions for BMD test and FRAX® usage, with regression coefficients of-2583.3 and-410.5, respectively, was demonstrated. A significant and nonsignificant increase, with regression coefficients of 71579.4 and 814.1 regarding the number of prescriptions for serum vitamin D and serum calcium tests, respectively, was highlighted. A statistically significant decrease in the number of prescriptions for alendronate and calcitonin, with regression coefficients of-9592.0 and-2272.3, respectively, was noted. Conclusions: The present study demonstrated that the COVID-19 pandemic negatively affected the diagnosis and treatment of osteoporosis. However, it was limited by the lack of data on prescriptions for other osteoporosis medications and diagnostic tests, the lack of access to the data on prescriptions for people whose costs are not covered by the IHIO, and the restricted data access regarding the presented data. The findings are based on prescription-level data in Iran and primarily reflect practice within this healthcare context; therefore, caution is required when generalizing to settings with different healthcare systems or population structures. Further studies are needed to assess this impact and to help prevent management disruption in future health crises. © 2025, Hajivalizadeh et al.